Insurance Analyst

Duties: "Performs account review, follow-up and collections to include double recoupment, correspondence and credit balance resolution.Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
Manages new accounts, on a daily basis, by working within Receivables Workstation. Interfaces with other departments within the hospital, when appropriate, to obtain information necessary to process or resolve claims. Contacts patient and/or account guarantor to solicit payment on account.
Works all accounts listed in the Follow-Up queue, on a daily basis to promote collection of accounts. This will include telephoning the payer, messaging or identifying the claim on the payers' Internet websites.
Manages account inventory on a timely basis to promote payment and resolution of all accounts as instructed by management.
Stays current on all payer requirements by reading bulletins, reviewing provider handbooks, accessing websites, etc.
Processes incoming correspondence, including signature letters, denials, prior authorizations and additional information necessary to process the claim.
Records newly identified insurance plans and facilitates the account processing of new plan in accordance with pre-billing policies and procedures.
Records accurate and definitive notes in the electronic account file that depict the current status of account, issues with account and anticipated date of resolution.
Escalates account management to Supervisor when issues arise, if needed.
Ensures PFS management is kept up to date with contract, payer or system changes and/or issues.
Assigns a status code to each worked account to enable account tracking, statistical data gathering and audit activities.
Manages new credit balance accounts every day and prepares adjustments or refunds to zero the account balance.
Handles special projects as directed by management e.g. high dollar accounts, accounts over 180 days old, etc.
Attends, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines as requested.
Maintains productivity standards by payer assignment.
Performs other job related tasks as assigned."
Skills: "Knowledge of Compliance Regulations and Medical Billing and Coding
Customer Service and Communication
Time Management and Organization
Teamwork and Collaboration"
Keywords:
Education: "Education
Required: High school diploma, GED or higher level degree
Licensure/Certification
N/A
Experience
Required: One (1) year of billing/collections experience, billing certification or prior successful internship/temporary assignment in a patient financial service setting
Preferred: Experience with managed care and Medicare/Medi-Cal Billing regulations"
Skills and Experience:
Required Skills:
BILLING/COLLECTIONS
CUSTOMER SERVICE
TIME MANAGEMENT
MEDICARE
CODING
Additional Skills:
BILLING
CORRESPONDENCE
MANAGED CARE
COLLECTIONS
MEDICAL BILLING
INVENTORY
RECEIVABLES
MEDICAL INVOICING
RETAIL SALES
CLAIMS
NEW ACCOUNTS
ADJUSTMENTS
CREDIT ISSUES
AUDIT
QUEUE MANAGEMENT
ACCOUNT MANAGEMENT
AIR COMPLIANCE
COLLECTION
PFS
CUSTOMER SERVICE ORIENTED
Languages:
English
Read
Write
Speak
Minimum Degree Required: Completed High School (Diploma or GED)